Older Adults Who are Stronger and Able to Function Well Have Better Outcomes When Hospitalized with Critical Illnesses

JAGS graphicJournal of the American Geriatrics Society Research Summary

Older adults are more likely than younger adults to develop critical illnesses that require hospitalization and intensive care. These illnesses include severe pneumonia and other serious respiratory conditions, congestive heart failure, heart attacks, and sepsis (a life-threatening complication from bacterial infections).

Until now, the role of strength before hospitalization has not been well-studied. Strength’s effects on how well older adults do following an intensive care unit (ICU) stay also have not been well-studied. To fill this knowledge gap, a research team created a study. The study wasto learn how older adults’ strength before they became ill affected how long they stayed in the hospital after being admitted to an ICU. They also learned whether or not the older adults died while in the hospital or within a year after discharge. Their study was published in the Journal of the American Geriatrics Society.

The researchers enrolled 575 people who had been admitted to the ICU one or more times. Participants were between the ages of 70 and 79 and lived in Memphis, TN, and Pittsburgh, PA, between March 1997 and July 1998. The participants had taken strength tests within two years before their admission to the ICU. Tests included walking 20 meters (about 64 feet), completing repeated chair stands, and assessing balance and grip strength.

The researchers learned that:

  • Participants with the slowest walk speeds had an 80 percent higher risk of dying within 30 days of their ICU admission. They had twice the risk of dying within one year of their ICU admission, compared to participants with the fastest walk speeds.
  • Participants with the poorest balance had a 77 percent higher risk of dying within 30 days of their hospital admission compared to participants with the fastest walk speeds.
  • Participants whose balance was rated as “moderate” had a 52 percent higher chance of dying within 30 days of their ICU admission.

What’s more, the researchers found that older adults who were weaker had longer hospital stays.

The researchers also noted that slower pre-hospital walk speed in particular was very strongly linked both to death and longer hospital stays.

This summary is from “The Influence of Pre-hospital Function and Strength on Outcomes of Older Critically Ill Adults.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are D. Clark Files, MD; Rebecca Neiberg, MS; Julia Rushing, MStat; Peter E. Morris, MD; Michael P. Young, MD; Hilsa Ayonayon, PhD; Tamara Harris, MD; Anne Newman, MD, MPH; Susan Rubin, MD; Eric Shiroma, MEd; Denise Houston, PhD; Michael E. Miller, PhD; and Stephen B. Kritchevsky, PhD.

Can Special Training Improve Memory and Thinking Abilities in Older Adults with Mild Cognitive Impairment?

JAGS graphicJournal of the American Geriatrics Society Research Summary

Cognition is the ability to think and make decisions. Medication-free treatments that maintain cognitive health as we age are attracting the attention of medical experts. Maintaining the ability to think clearly and make decisions is crucial to older adults’ well-being and vitality.

Mild cognitive impairment (MCI) is a condition that affects people who are in the early stages of dementia or Alzheimer’s disease. People with MCI may have mild memory loss or other difficulties completing tasks that involve cognitive abilities. MCI may eventually develop into dementia or Alzheimer’s disease. Depression and anxiety also can accompany MCI. Having these conditions can increase the risk of mental decline as people age.

A new, first-of-its-kind study was published in the Journal of the American Geriatrics Society by scientists from research centers in Montreal and Quebec City, Canada. They designed a study to learn whether cognitive training, a medication-free treatment, could improve MCI. Studies show that activities that stimulate your brain, such as cognitive training, can protect against a decline in your mental abilities. Even older adults who have MCI can still learn and use new mental skills.

For their study, researchers recruited 145 older adults around the age of 72 from Canadian memory clinics. The participants had been diagnosed with MCI, and were assigned to one of three groups. Each group included four or five participants, and met for eight weekly sessions for 120 minutes.

The three groups were:

  • Cognitive training group. Members of this group participated in the MEMO program (MEMO stands for a French phrase that translates to “training method for optimal memory”). They received special training to improve their memory and attention span.
  • Psycho-social group. Participants in this group were encouraged to improve their general well-being. They learned to focus on the positive aspects of their lives and find ways to increase positive situations.
  • Control group. Participants had no contact with researchers and didn’t follow a program.

During the time the training sessions took place, 128 of the participants completed the project. After six months, 104 completed all the sessions they were assigned.

People in the MEMO group increased their memory scores by 35 to 40 percent, said Sylvie Belleville, PhD, a senior author of the study. “Most importantly, they maintained their scores over a six-month period.”

What’s more, the improvement was the largest for older adults with “delayed recall.” This means memory for words measured just 10 minutes after people have studied them. Because delayed memory is one of the earliest signs of Alzheimer’s disease, this was a key finding.

Those who participated in the MEMO group said they used the training they learned in their daily lives. The training gave them different ways to remember things. For example, they learned to use visual images to remember names of new people, and to use associations to remember shopping lists. These lessons allowed them to continue maintaining their memory improvements after the study ended.

The people in the psycho-social group and the control group didn’t experience memory benefits or improvement in their mood.

This summary is from “MEMO+: efficacy, durability and impact of cognitive training and psychosocial intervention in MCI.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Sylvie Belleville, PhD; Carol Hudon, PhD; Nathalie Bier, PhD; Catherine Brodeur, MD; Brigitte Gilbert, PhD; Sébastien Grenier, PhD; Marie-Christine Ouellet, PhD; Chantal Viscogliosi, PhD; and Serge Gauthier, MD.

Older Adult-Friendly Emergency Department Staff Help Reduce Hospital Admissions

JAGS graphicJournal of the American Geriatrics Society Research Summary

When older adults arrive at a hospital’s emergency department (ED), they may face unexpected challenges. For example, they may become less able to function independently. They may develop difficulties thinking and making decisions during or following a visit to the ED. This makes transitions in care to and from the ED an important area for improvement in our health care as we age.

To address these challenges, geriatrics experts have developed special programs such as the “Geriatric Emergency Department Innovations in Care through Workforce, Informatics, and Structural Enhancements” (GEDI WISE) program. GEDI WISE is an award-winning program that serves as a model for excellence in emergency care for older adults in three large urban hospitals: Mount Sinai Medical Center in New York, NY; St. Joseph’s Regional Medical Center in Paterson, NJ, and Northwestern Memorial Hospital in Chicago, IL.

One piece of the GEDI WISE program includes an ED-based geriatrics transition care nurse (TCN). The TCN identifies patients who have health needs specific to older adults. This nurse works to help people transition to their homes so that they can avoid hospital admission whenever possible.

A team of researchers designed a study to learn how effective the GEDI WISE TCNs were for reducing hospital admissions, later admissions, and revisits to the ED. They published their findings in the Journal of the American Geriatrics Society.

The study took place in 2013-2015 in all three hospitals in the GEDI WISE program. They studied more than 57,000 people aged 65 or older who made more than 120,000 visits to the three participating hospitals’ EDs.

The TCN nurses gave the older adults several different screenings, including tests for:

Informed by these screenings, the TCN used various geriatrics resources to help patients. Some people required only a little support, while others needed extensive help.

Older adults who saw the TCN at least once during the study period were included in the “intervention group.” Older adults who didn’t see the TCN during the study period were included in the “control group.”

Compared to the control group, people who saw the TCN had lower rates of inpatient (hospital or healthcare facility) admissions over 30 days at two of the three hospitals.

The researchers concluded that programs focusing on improving care transitions for older people seen in the ED may help reduce the risk for hospital admission.

This summary is from “Geriatric Emergency Department (ED) Innovations: ED transitional care nurses & hospital utilization.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Ula Hwang, MD, MPH; Scott M. Dresden, MD; Mark S. Rosenberg, DO, MBA; Melissa M. Garrido, PhD; George Loo, DrPh; Jeremy Sze, BS; Stephanie Gravenor, MBA; D. Mark Courtney, MD; Raymond Kang, MA; Carolyn Zhu, PhD; Carmen Vargas-Torres, MS; Corita R. Grudzen, MD, MSHS; Lynne D. Richardson, MD; and the GEDI WISE Investigators.

Older Adults with Metabolic Syndrome May be More Resistant to Depression Treatments

JAGS graphicJournal of the American Geriatrics Society Research Summary

Researchers suspect that having Metabolic Syndrome makes it harder for older adults to respond to therapies for depression. (Metabolic Syndrome is a mix of conditions like increased blood pressure, high blood sugar levels, excess body fat around the waist, and abnormal cholesterol levels). In a new, first of its kind study, published in the Journal of the American Geriatrics Society, researchers examined whether Metabolic Syndrome in depressed older adults affects their response to antidepressant treatment.

Older adults who have major depressive disorder (MDD, also known as depression) are at higher risk for having problems thinking and making decisions. They are more likely to have trouble performing their regular daily activities and managing their personal care. These problems can lead to poorer health in general and a higher risk of death compared to older adults who are not depressed. Continue reading

Measured with Fitness Trackers, Light Intensity Physical Activity Linked to Lower Mortality in Women 63 to 99

JAGS graphicJournal of the American Geriatrics Society Research Summary

Experts say that a lack of physical activity leads to age-related weakness and poor health in older adults. Official guidelines suggest that healthy older adults spend at least 2.5 hours every week doing moderate activity (such as brisk walking), or at least 1.25 hours per week doing vigorous exercise (such as jogging or running).

Unfortunately, many older adults are not physically able to perform either moderate or vigorous intensity exercise. Researchers created a study to learn more about how much exercise older adults are able to perform, and how that exercise affects their health.

The research team studied 6,489 female participants aged 63 to 99 years old. The researchers published their findings in the Journal of the American Geriatrics Society.

The participants agreed to take in-home exams, answer health questionnaires, and wear accelerometers (devices similar to fitness trackers). The participants also kept sleep logs.

The study was conducted between 2012 and 2013. The researchers reviewed death certificates as of September 2016 to learn how many participants had died. Continue reading